Program Goals

The goals of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) are:

• Reduce abuse or neglect
• Reduce out-of-home placement
• Improve parenting (without violence, psychological aggression, or neglect)
• Improve parent mental health functioning
• Improve youth mental health functioning
• Increase social support

Logic Model

View the Logic Model for Multisystemic Therapy for Child Abuse and Neglect (MST-CAN).

Essential Components

The essential components of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) include:

• Clients:
• Youth between the ages of 6 and 17
• Youth who have come to the attention of child protective services due to physical abuse and/or neglect and for whom the abuse report was filed within the last 180 days
• Youth who are currently in foster care or another out-of-home placement and will be reuniting with their family
• Intervention Context:
• Services provided in the family's home or other places convenient to them and at times convenient to the family
• Intensive services, with intervention sessions being conducted from three times per week to daily
• 24/7 on-call roster utilized to provide round-the-clock services for families
• Treatment provided to multiple children in the family and one or both parents, with a greater emphasis on parent treatment than standard MST
• Therapists and Supervisors
• MST-CAN staff work on a clinical team of 3 therapists, a crisis caseworker, a part-time psychiatrist, and a full-time supervisor
• MST-CAN supervisor must have the following criteria:
• An understanding of the child protective services system
• Experience with family therapy and cognitive behavioral therapy for posttraumatic stress disorder (PTSD)/trauma
• Experience in managing severe family crises that involve safety risk to the children or entire family
• A thorough understanding of state mandated abuse reporting laws
• A PhD or Master's degree in counseling, social work, or a related field
• Supervisors must be full-time and may supervise a single team only
• The MST-CAN therapist must have a Master's degree in counseling, social work, or a related field
• The MST-CAN Team must have access to an appropriate percentage of an adult and child psychiatrist's time that has been trained in the MST and MST-CAN treatment models and is integrated into the clinical team
• The MST-CAN team must include one full-time crisis caseworker with a Bachelors degree
• Application of the Intervention:
• Interventions developed along an analytical model that guides the therapist to assess factors that are driving clinical problems and then applied to the driving factors or "fit factors"
• All interventions evidence-based or evidence-informed
• Each therapist carries a maximum caseload of 4 families and case length is 6-9 months
• Program Fidelity and Quality Assurance:
• Each team member completes a 5-day MST orientation training, a 4-day MST-CAN training, and 4 days of training in adult and child trauma treatment
• Weekly on-site group supervision
• Weekly telephone consultation with an MST-CAN expert
• Quarterly on-site booster trainings conducted by the MST-CAN expert
• Measurement of model adherence through monthly phone interviews with the parent or caregiver.
• Program Monitoring and Use of Data:
• Agencies collect data as specified by MST Services and all data are sent to the MST Institute (MSTI) which is charged with keeping the national database system.
• MSTI data reports used to assess and guide program implementation
• Agencies use these reports to monitor and assure fidelity to the MST model
• There must be a formal Memorandum of Agreement (MOA) in place regarding access to abuse and placement data prior to implementation

Program Delivery

Child/Adolescent Services

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) directly provides services to children/adolescents and addresses the following:

• Physical abuse and/or neglect for which the report to child protective services was filed within the last 180 days, youth aggression, anxiety and trauma/PTSD, substance abuse, difficulty managing anger, safety risks, difficulties with family problem solving, negative family communication, physical force in parenting, neglectful parenting, parental psychological aggression, low social support, parental blame of the child for the abuse/neglect, and school difficulties

Parent/Caregiver Services

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) directly provides services to parents/caregivers and addresses the following:

• Has a child who experienced physical abuse and/or neglect for which the report to CPS was filed within the last 180 days, anxiety and trauma/PTSD, depression, substance abuse, difficulty managing anger, safety risks, difficulties with family problem solving, negative family communication, physical force in parenting, neglectful parenting, parental psychological aggression, low social support, parental blame of the child for the abuse/neglect, and difficulties maintaining housing or jobs

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Direct treatment services provided to family. Collaboration with other supportive individuals, including them as part of the treatment team

Recommended Intensity:

Services are intensive, with intervention sessions being conducted from three times per week to daily. However, there is no expectation of a specific number of contact hours, as staff contact waxes and wanes according to the needs of the families. Session length depends on the needs of the family and may range from 50 minutes to 2 hours. Multiple types of sessions may be conducted in one day (e.g., parental drug screening and session; family communication and problem solving).

Recommended Duration:

6-9 months

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Foster / Kinship Care
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) includes a homework component:

Homework may be assigned in relation to any of the following interventions:

• Parent Management Training
  
• Treatment of caregiver posttraumatic stress disorder (PTSD)
  
• Treatment for anger management
  
• Treatment for caregiver substance abuse
  
• Family communication training

Languages

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) has materials available in languages other than English:

Dutch, Norwegian, Swiss German

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Office space to house the team and conduct consultation and supervision is required as well as laptops and mobile phones for all staff.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

MST-CAN Supervisor:

• Must be assigned to MST-CAN 100%.
• Must have a Master's degree in counseling, social work, or a related field
• Must be independently licensed.
• May only supervise a single team
• May not carry their own caseload
• Must have an understanding of the child welfare system
• Must have experience in managing severe family crises that involve safety risk to the children and/or entire family
• Must have a thorough understanding of state and national mandated abuse reporting laws
• Should have experience implementing Standard MST or MST-CAN
• Should have knowledge and experience in the MST-CAN Supervision Model
• Should have experience with family therapy and Cognitive-Behavioral Therapy (CBT) for Post-traumatic Stress Disorder (PTSD)

MST-CAN Therapist:

• Must be assigned to a single MST-CAN team 100%
• Must have a Master's degree in counseling, social work, or a related field
• Should have a background in child development
• Should have an understanding of family violence
• Should have skills in engaging families reluctant to participate
• Should have experience in crisis intervention where homicidal or suicidal risk is present
• Should have knowledge of the child welfare system.

MST-CAN Crisis Caseworker:

• Must be assigned to a single MST-CAN team 100%
• Must have a minimum of a Bachelor's degree
• Should have knowledge, of interventions related to practical life skills such as employment seeking, budgeting, and housing
• Should have experience in the child welfare system
• Should have knowledge of child development

MST-CAN Psychiatrist:

• Must be available to team at least 8 hours per week
• MD or DO, board certification eligibility in Child and Adolescent Psychiatry
• Must be trained in the MST treatment model and the MST-CAN adaptations by MST, Inc.
• Must have a thorough understanding of state and national mandated abuse reporting laws
• Should have a thorough understanding of existing ethical guidelines and laws concerning clinical situations that may occur in crisis treatment (i.e., restraints, commitments, reporting abuse or neglect)
• Should have experience with both child and adult populations
• Should have experience in trauma treatment for youth and adults
• Should have experience working in local organizations and systems

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Swenson, C. C., Penman, J. E., Henggeler, S. W., & Rowland, M. D. (2011). Multisystemic Therapy for Child Abuse and Neglect, revised edition. Family Services Research Center, National Institute of Mental Health, and Connecticut Department of Children and Families.

Training Information

There is training available for this program.

Training Contact:

• Joanne Penman
  MST Services
  joanne.penman@mstservices.com
  phone: (843) 284-2222
  fax: (843) 856-8227

Training Type/Location:

Training is only available to staff who will be implementing MST-CAN in a licensed program. With regard to the initial 5-day MST orientation, organizations can access the training in one of two ways. New staff can come to Charleston, SC and participate in one of the quarterly open-enrollment trainings provided by MST Services Inc. Alternatively, providers can elect to have MST Services Inc. conduct an additional 5-day initial training at their site. MST-CAN training and the 4-day trauma training are provided on site by MST-CAN experts at this time. After start-up, training continues through weekly telephone MST-CAN consultation and on-site quarterly booster trainings for each team of MST-CAN clinicians.

Number of days/hours:

All trainees complete the Standard MST 5-day orientation. Then each team member completes a 4-day MST-CAN specific training and 4 days of training in adult and child trauma treatment. All training is open to CPS caseworkers who will be working with the MST-CAN team.

After start-up, training continues through weekly telephone MST-CAN consultation for each team of MST-CAN clinicians aimed at monitoring treatment fidelity and adherence to the MST-CAN treatment model, and through quarterly on-site booster trainings (1 1/2 days each). Trained MST-CAN experts will teach the MST-CAN supervisor to implement a manualized MST supervisory protocol and collaborate with the supervisor to promote the ongoing clinical development of all team members. The MST-CAN expert will also assist at the organizational level as well as needed.

Additional Resources:

There currently are additional qualified resources for training:

Agencies that are licensed by MST Services Inc. as Network Partner Organizations can provide the MST 5-day orientation training.

At this time all MST-CAN trainings are provided by MST-CAN experts affiliated with MST Services or the Medical University of South Carolina.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) as listed below:

MST Services, the company that disseminates MST and MST-CAN has developed site assessment tools that have been used for the last 25 years with standard MST and for the last 10 years with MST-CAN. The tools include a review of the feasibility of the program, goals, and guidelines for implementation and implementation and program practice requirements that must be met. Furthermore, each site must pass a formal Site Readiness Review conducted on site. These tools are not available to the general public and are only used when a site is moving forward with implementation of an MST-CAN program.

Formal Support for Implementation

There is formal support available for implementation of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) as listed below:

The ongoing MST-CAN implementation support that is provided after the orientation training, has been developed to replicate the characteristics of training, clinical supervision, consultation, and monitoring provided in the clinical trials of MST and MST-CAN. After start-up, support continues through weekly telephone MST-CAN consultation for each team of MST-CAN clinicians aimed at monitoring treatment fidelity and adherence to the MST-CAN treatment model, and through quarterly on-site booster trainings (1.5 days each). MST-CAN experts teach MST-CAN supervisors to implement the MST supervisory protocol and collaborate with the supervisor to promote the ongoing clinical development of all team members. In addition, therapists audiotape sessions of trauma treatment for children or adults. The supervisor and expert listens to the tape, rates it for convergence on adherence to the session, and offers feedback on next steps.

Ongoing organizational assistance aims to overcome barriers to achieving successful clinical outcomes through services that may include a comprehensive business planning process, promotion of the MST-CAN program within the broader service community, and developing program-level interventions designed to increase referrals, reduce staff attrition, or restructure program funding mechanisms to increase sustainability.

Quality assurance support activities focus on monitoring and enhancing program outcomes through increasing therapist adherence to the MST and MST-CAN treatment model.

Fidelity Measures

There are fidelity measures for Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) as listed below:

Therapist Adherence Measure-Revised (TAM-R): This is an objective, standardized instrument that evaluates a therapist’s adherence to the core MST model as reported by the primary caregiver of the family. The TAM-R has been validated in clinical trials with serious, chronic, juvenile offenders, and is now implemented by all licensed MST programs. The TAM-R is available through MST Services but is used only for MST programs (www.mstservices.com).

The CAN Therapist Adherence Measure-Revised (CAN TAM-R): This measure is the TAM-R plus additional items that measure adherence to the MST-CAN model. The MST-CAN TAM-R takes 10 to 15 minutes to complete. It is administered during the second week of treatment and every four weeks thereafter. An independent MST-CAN interviewer contacts the family by phone to complete the measure. Data are entered onto an on-line database managed by the MST Institute, and results are reviewed by the MST-CAN Supervisor and Therapist. The full CAN TAM-R is entered into a database housed at the Medical University of South Carolina. The CAN TAM-R is not available to the general public at this time as it is considered a research instrument.

Supervisor Adherence Measure (SAM): This measure evaluates the MST-CAN Clinical Supervisor’s adherence to the MST model of supervision. This 10– to 15–minute measure is completed by MST-CAN Therapists, who are prompted to complete the SAM every two months and enter their responses directly onto the online database. Results are shared with the MST-CAN Expert, who then shares a summary of the feedback with the MST-CAN Clinical Supervisor during a consultation meeting. The SAM is available through MST Services but is used only for MST programs (www.mstservices.com).

Consultant Adherence Measure (CAM): The MST-CAN Therapists and MST-CAN Supervisors are responsible for completing this questionnaire. Times will be scheduled one month after completion of the first SAM, and every two months thereafter. It is estimated that the time commitment required is 10 to 15 minutes per respondent for each administration. The CAM consists of 23 items that measure consultation behavior in three domains. The CAM is available through MST Services but is used only for MST programs (www.mstservices.com).

Established Psychometrics:

Schoenwald S. K., Letourneau, E. J., & Halliday-Boykins, C. A. (2005). Predicting therapist adherence to a transported family-based treatment for youth. Journal of Clinical Child and Adolescent Psychology, 34(4), 658–670. https://doi.org/10.1207/s15374424jccp3404_8

Schoenwald, S. K., Sheidow, A. J., Letourneau, E. J., & Liao, J. G. (2003). Transportability of Multisystemic Therapy: Evidence for multi-level influences. Mental Health Services Research, 5, 223–239. https://doi.org/10.1023/A:1026229102151

Implementation Guides or Manuals

There are implementation guides or manuals for Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) as listed below:

MST Services has developed manuals for training supervisors and experts and for teams to follow to prepare weekly treatment plans. The MST Organizational Manual is designed to provide useful information in addressing administrative issues that occur while developing and sustaining a MST program. These tools are not available to the general public.

Implementation Cost

There have been studies of the costs of implementing Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) which are listed below:

Dopp, A., Schaeffer, C. M., Swenson, C. C., & Powell, J. S. (2018). Economic impact of Multisystemic Therapy for Child Abuse and Neglect. Administration and Policy in Mental Health and Mental Health Services Research, 45, 876–887. https://doi.org/10.1007/s10488-018-0870-1

Watmuff, C., & Ross, E. (2016). Costs and benefits of MST-CAN in Leeds: A preliminary internal report to the Chief Officer Children’s Services. Leeds City Council.

York Consulting. (2014). MST-CAN preliminary FROI analysis. Report to the Cambridgeshire County Council.

Research on How to Implement the Program

Research has not been conducted on how to implement Multisystemic Therapy for Child Abuse and Neglect (MST-CAN).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcomes: Safety, Permanency and Child/Family Well-Being

Additional References